Week 5 (chap 11)

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2 streams of money in healthcare financing

1.) collection money for healthcare (going in) 2.) reimbursement of healthcare providers for care (going out)

A nurse has very strong client education skills. In which health care setting would the nurse make best use of these skills?

primary care center

Inpatient vs. Outpatient

*inpatient*: Admitted to the hospital overnight *Outpatient*: seen and sent home the same day

IHI Triple Aim

-population health -experience of care -per capita cost

rate setting

Government could set targets or caps for spending on health care services

IHI

Institute for Healthcare Improvement

PPACA =

Patient Protection and Affordable Care Act goal to decrease amount of uninsured

outpatients

Patients who do not require hospitalization but are under a physician's care

prospective payment plans

Pay by diagnosis: If care costs less, the agency absorbs the costs/ if care costs more, the agency covers the costs

HMOs (health maintenance org)

Prepaid care plans to receive all medical services through a group of affiliated providers

medicare vs medicaid

Provided health care to elderly vs. Provided health care to poor people

managed care

Provider receives a predetermined capitated payment for each patient.

medical neighborhood

a patient-centered medical home and the constellation of other clinicians providing health care services to patients within it

PPOs (preferred provider organizations)

a prepaid group practice to provide service at lower fee in return for prompt payment & guaranteed patient volume

hospice

a type of end-of-life care for persons who are terminally ill

Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?

affordable care act

comparative effectiveness analysis

assess and weigh the benefits and costs of new technologies make decisions about whether a medical benefit is worth the cost and whether it should be covered by a public or private insurance program

Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role?

collaborate with agencies to provide for client's home health needs

What is the goal of this health insurance coverage concept?

comparison of available health care plans

single-payer system

one entity (ex government) collects all healthcare fees & pays out costs

multipayer system

care is paid for by both private insurance companies and the government

respite care

care provided for caregivers of homebound ill, disabled, or elderly patients

extended-care services

caregivers that provide medical and nonmedical care for people with chronic illnesses who are unable to care for themselves independently

DRGs (diagnosis-related groups)

classification of patients by major medical diagnosis for the purpose of standardizing health care costs

care coordination

deliberate organization of patient care activities between two or more participants (including the patient)

health insurance marketplace

designed to help people more easily find health insurance that fits their budget and needs

The growth in home health care is largely attributed to which factor?

early discharge of patients from hospital settings

high reliability organizations

operate in a complex, high-hazard domain for an extended period without serious accidents or catastrophic failures

Capitation

gives providers a fixed amount per enrollee of health plan

healthy people 2030

goals will be focused on reducing health problems based on current trends client's health is affected by social, economic, and political factors

ACO (accountable care organization)

group of health care entities organized to deliver most efficient healthcare for specific pop

ambulatory care

health care settings located in areas that are convenient for people to walk into and receive care

ANA (american nursing association) main goal =

health promotion

palliative care

hospice care goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms

The diagnostic-related group is a part of which health care system?

medicare

Third-party payer

members pay monthly premiums in combination with employer payments

primary vs secondary vs tertiary healthcare

primary: common health problems secondary: problems require more specialized tertiary: management of rare disorders

entitlement reform

proposed legislation making changes in entitlement benefits such as Medicare and Medicaid paid by the government to citizens, with the goal of improving the nation's budget

medicare bases fee for payment on what

prospective payment plan based on predetermined fixed costs

medicare

provide health courage to all social security recipients

Bundled Payments

provider receives a fixed sum of money to provide a range of services

community health centers

regionalized services for vulnerable geographic populations with an emphasis on primary care and education

aging in place

remaining in the same home and community in later life, adjusting but not leaving when health fades

Value-based purchasing

requires Medicare and Medicaid Services to redistribute a portion of the payments to hospitals based on performance on quality measures

extended care

services that meet the health needs of clients who no longer require acute hospital care but require rehabilitation/nursing care

benefits to hospital at home program

shorter lengths of stay

parish nursing

specialty nursing practice emphasizes holistic care

fee-for-service

system in which a bill is generated and a fee is paid every time a provider does something for a patient

Which statement regarding health care reform trends is most accurate?

systems are in place to pay for performance and penalize hospitals for excessive readmissions

CHIP (Children's Health Insurance Program)

targets uninsured children whose families don't qualify for Medicaid

quality in healthcare

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes

medicaid

to make health care available to those who do not qualify for medicare

pay for performance

using financial incentives to reward providers for achieving a range of payer objectives

hospital at home program

when patients are treated in own homes by appropriate health care professionals


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